Extended Cost Effectiveness Analysis (ECEA): Evaluating Multiple Economic Outcomes of Health Interventions

Transcription

1 Extended Cost Effectiveness Analysis (ECEA): Evaluating Multiple Economic Outcomes of Health Interventions Rachel Nugent University of Washington Presented at the IOM Workshop on Evaluation Methods for Large-Scale, Complex, Multi-National Global Health Initiatives

2 Objectives of DCP3 Inform allocation of resources across interventions and health service delivery platforms. Provide a comprehensive review of the efficacy and effectiveness of priority health interventions. Advance knowledge and practice of analytical methods for economic evaluation of health interventions. 1/17/2014 5

3 Overview Background Health spending decisions are about packages, platforms, policies Need to broaden the results of economic evaluation CEA..ECEA.CBA Multiple Health System Outcomes Equity Definitions Financial risk protection Definitions Example Expanded HPV screening, vaccination, cervical cancer treatment in China

4 Health system objectives Improving health and the distribution of health in the population Prevention of medical impoverishment Fairness in the financial contribution toward health

5 Coverage (%) Fairness in the distribution of health coverage (ex: measles vaccine coverage) Measles deaths Measles deaths per 1,000,000 births Income Quintile (Poorest to Richest) Measures of equity Coverage (%) Measles vaccine coverage Income Quintile (Poorest to Richest) Fairness in the distribution of health outcomes (ex: measles deaths)

6 Measures of medical impoverishment When confronted with medical expenditures and inadequate financial protection, people can face high out-of-pocket (OOP) payments and fall into poverty Threshold-base approach Poverty cases averted Forced Borrowing and Asset Sales Money-metric value of insurance

7 Mechanisms of financial risk protection Moving from out-of-pocket payments to prepayment mechanisms reduces catastrophic expenditures (Xu et al. 2007; cross-country study) Public finance & social insurance packages bring significant risk reductions México s Seguro Popular in 2004 (Knaul et al. 2006) Medicare in the US (Finkelstein and McKnight 2008)

8 From CEA to ECEA Cost Effectiveness Analysis (CEA) Extended Cost Effectiveness Analysis (ECEA) (1) Distributional consequences across wealth strata of populations (2) Financial risk protection benefits for households Verguet, Laxminarayan & Jamison, Health Economics (in press)

9 HPV vaccination policy in China

10 Summary measures of ECEA Health policy lever for an intervention (e.g. HPV vaccination program) Health gains (e.g. Cancer deaths averted) Household expenditures (e.g. Cancer treatment expenditures averted) Financial risk protection benefits (e.g. relative importance of treatment expenditures) Poorest 2 nd Poorest Middle 2 nd Richest Richest

11 Benefits and costs of a publically financed HPV vaccination policy in China (US $ 2009)

12 Savings as a % of income Absolut Savings HPV in China: Savings and FRP Absolute Savings vs. Financial Risk Protection 70% $9,000,000 60% 50% $8,000,000 $7,000,000 $6,000,000 40% $5,000,000 30% $4,000,000 20% 10% $3,000,000 $2,000,000 $1,000,000 0% Quintile $- Savings as a percentage of income Patient Cost Savings

13 Priority setting & UHC Goal: Design basic insurance packages, taking into account burden, costs, equity, medical impoverishment Low Health gains High FRP High Health gains High FRP FRP Low Health gains Low FRP High Health gains Low FRP FRP = financial risk protection (prevention of medical impoverishment) Deaths averted

14 Summative observations Comparable quantitative measures are very powerful Precarious tension between complex contextualized model and generalized analysis Difficult to get data sufficiently broadly across disease/health topics, levels of health system, and population characteristics in a given country Importance of working with people who know their health systems, population, and policy priorities

15 Acknowledgements DCPN-UW Team Dean Jamison Stéphane Verguet Rachel Nugent Carol Levin Elizabeth Brouwer Zach Olson Shane Murphy HPV ECEA Team Carol Levin Sue Goldie Jane Kim Monisha Sharma Zach Olson Stephane Verguet Dean Jamison